一期后路清创椎间植骨融合负压封闭引流联合闭合式灌洗引流治疗腰椎原发性感染的疗效观察

Clinical efficacy of one-stage posterior debridement, interbody bone grafting and vacuum sealing drainage combined with closed continuous douche drainage in treating primary lumbar spine infection

中文关键词:  腰椎原发性感染  椎旁脓肿  负压封闭引流  闭式灌洗引流  植骨融合术

英文关键词:Primary lumbar spine infection  Paravertebral abscess  Vacuum sealing drainage  Closed continuous douche  Bone graft fusion

中文摘要:

  【摘要】 目的：观察一期后路清创取髂骨椎间植骨融合、负压封闭引流（vacuum sealing drainage，VSD）敷料封闭切口联合闭式灌洗引流术（closed continuous douche，CCD）治疗腰椎原发性感染的临床疗效。方法：回顾性分析 2016年1月~2021年12月在我院采用一期后路清创取髂骨椎间植骨融合联合VSD敷料封闭切口+CCD治疗的18例腰椎原发性感染的病例资料，其中男9例，女9例；年龄22~80岁（53.2±16.0岁）。采用mNGS测序联合病原学培养鉴定患者感染病原体，制定针对性的抗生素治疗方案；通过检测术前3d~术后60d（间隔3d）的ESR和CRP，评估感染的控制状况；通过术前和术后3个月的Barthel指数（Barthel index，BI）和腰椎JOA评分，计算BI、JOA评分与对应的改善率（改善率≥60%为显效），评估临床功能恢复情况；记录术前和术后3个月的Frankel分级评价脊髓损伤恢复；观察患者术后随访时的CT，记录植骨融合时间。结果：mNGS测序联合病原学培养结果阳性17例（17/18），金黄色葡萄球菌8例，大肠埃希菌3例，铜绿假单胞菌2例，耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌、布鲁氏杆菌均为1例，均采用了相应的序贯治疗。术后所有病例获得随访，随访时间12~38个月（18.0±8.2个月），CRP和ESR的平均水平于术后42d和45d分别恢复并持续维持在正常范围。术前BI为63.7±11.3分，术后3个月为89.8±7.0分，16例达到显效（88.9%）；术前JOA评分14.2±3.4分，术后3个月25.7±3.1分，16例达到显效（88.9%）。术后3个月的随访时，2例Frankel C级患者恢复至E级，2例恢复至D级，其余14例Frankel D级患者均恢复至E级。术后植骨融合时间平均6.0±1.5个月。结论：一期后路清创取髂骨椎间植骨融合联合VSD封闭切口+CCD技术治疗腰椎原发性感染可以充分清创、有效控制感染，植骨融合可靠，可以有效改善患者神经功能。

英文摘要:

  【Abstract】 Objectives: To observe the clinical efficacy of one-stage posterior debridement and iliac bone interbody fusion combined with vacuum sealing drainage(VSD) for wound closure and closed continuous douche (CCD) for the treatment of primary lumbar spine infection. Methods: A retrospective analysis was conducted on the case data of 18 patients with primary lumbar spine infection who underwent one-stage posterior debridement with iliac bone interbody grafting and VSD incision closure + CCD treatment at our hospital between January 2016 and December 2021. There were 9 males and 9 females, aged 53.2±16.0 years(22-80 years). mNGS sequencing and pathogen culture were employed to identify infectious pathogens and formulate targeted antibiotic treatment plans. The levels of erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) were measured from preoperative 3d to postoperative 60d(every 3 days) to evaluate the infection control status. Clinical function recovery was assessed using the Barthel index(BI) and JOA scores before surgery and at 3 months postoperatively, calculating the improvement rates(significant improvement defined as ≥60%). The Frankel classification was recorded before operation and at 3 months post-operation to evaluate spinal cord injury recovery. Postoperative follow-up CT scans were conducted to record the time to bone fusion. Results: The combined results of mNGS sequencing and pathogenic culture were positive in 17 cases (17/18), including 8 cases of Staphylococcus aureus, 3 cases of Escherichia coli, 2 cases of Pseudomonas aeruginosa, 1 case each of methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, and Brucella species was also noted, all of which received appropriate sequential therapy. All the cases were followed up postoperatively for 18.0±8.2 months(12-38 months). The average levels of CRP and ESR returned to the normal ranges on postoperative 42d and 45d respectively and sustained thereafter. The BI was 63.7±11.3 points before operation, which was 89.8±7.0 points at 3 months postoperatively, with 16 cases achieving significant improvement(88.9%); The JOA score was 14.2±3.4 points before operation, which was 25.7±3.1 points at 3 months postoperatively, with 16 cases achieving significant improvement (88.9%). At 3 months after operation, 2 patients with Frankel grade C improved to grade E, 2 improved to grade D, and the remaining 14 patients with Frankel grade D all improved to grade E. The average time for bone graft fusion post-surgery was 6.0±1.5 months. Conclusions: One-stage posterior debridement, iliac bone interbody grafting, and VSD incision closure combined with CCD can achieve thorough debridement, effective infection control, and reliable bone graft fusion in treating primary lumbar spine infection, which can improve neurological function of the patients.